Approach to Life-Threatening Hemoptysis

Abstract

The classic concept of massive hemoptysis has been replaced by the newer one of life-threatening hemoptysis (LTH), which means any bleeding from the lower respiratory tract that may cause the death of the patient. Although asphyxia is the usual mechanism of death, hypovolemic shock also plays a role in certain cases. The amount of expectorated blood does not always correlate with the actual volume of bleeding. The underlying state of health, especially basal respiratory function, plays a crucial role when the real consequences of bleeding are considered. The following factors have to be evaluated when a temporary or definitive treatment is chosen: setting of the hemoptysis, presumptive etiology, degree of clinical instability, equipment resources, and personal expertise in different techniques. The most important role of bronchoscopy is its rapid availability when hemoptysis is severe and the patient is not sufficiently stable to be immediately taken to the angiography department. In that situation, orotracheal intubation and bronchoscopy may be lifesaving. Rigid bronchoscopy, in skilled hands, has proven to be superior to flexible bronchoscopy in massive hemoptysis. Fiberoptic bronchoscopy (FOB) is also helpful as an extreme emergency measure to properly place an orotracheal tube contralateral to the bleeding side. Endoscopic local measures may sometimes help to transitorily stop bleeding. If the cause of hemoptysis is itself susceptible to primary surgical treatment and the condition of the patient is sufficiently good in terms of pulmonary reserve, life expectancy, and hemodynamic stability, then surgery is indicated. If the condition of the patient is not good enough, a temporary method to stop hemorrhage and stabilize the patient is then warranted. Although bronchoscopy and bronchial artery embolization (BAE) should be ideally complementary, recent data suggest that BAE may be a more effective temporary measure to stop bleeding.

Pulmonary Toxicity Caused by Cytotoxic Drugs

“…21,22 Life-threatening hemoptysis and massive alveolar hemorrhage should be treated according to the specific cause of bleeding. 23 Diffuse alveolar hemorrhage after bone marrow transplant may respond to the infusion of recombinant factor VIIa. 24 It has been suggested that the use of amiodarone to treat cardiac dysrhythmias in patients under chemotherapy could enhance potential chemotherapy-induced lung toxicity.…”

Hemoptisis amenazante: un desafío continuo de tratamiento multidisciplinario

“…La realizació n de este procedimiento no es posible en el 5-10% de los casos (imposibilidad de cateterizar todas las arterias, inestabilidad del caté ter o riesgo de ocluir una colateral no bronquial) y no debería considerarse como una solució n definitiva aunque mejore los resultados conseguidos por la fibrobroncoscopia en el control del sangrado 25,26 . Es aplicable en la fase má s aguda y hasta poner en marcha un tratamiento mé dico o quirú rgico má s definitivo, aunque puede realizarse con una intenció n má s definitiva ante la imposibilidad o el fracaso de estos ú ltimos 27,28 .…”

“…Su reconocida utilidad y amplia implantació n recogida en mú ltiples estudios publicados en la literatura mé dica estos ú ltimos añ os no se acompañ a de un conocimiento amplio de la evolució n de estos pacientes a largo plazo. El resangrado tras la embolizació n es inferior al de la fibrobroncoscopia y atribuible a una embolizació n incompleta, revascularizació n o recanalizació n de la arteria asociada a una dificultad de control de la enfermedad de base 25,26 . El resangrado tras la embolizació n es inferior al de la fibrobroncoscopia y atribuible a una embolizació n incompleta, revascularizació n o recanalizació n de la arteria asociada a una dificultad de control de la enfermedad de base 25,26 .…”